0) { $upload_DstName[$i] = $prefix . "_" . str_replace(" ", "_", $_FILES[$key]['name']); $upload_SrcName[$i] = $_FILES[$key]['name']; $upload_Size[$i] = ($_FILES[$key]['size']); $upload_Temp[$i] = ($_FILES[$key]['tmp_name']); $upload_Type[$i] = ($_FILES[$key]['type']); $uploadlink[$i] = "$upload_folder/$upload_DstName[$i]"; $upload_fieldname[$i] = $key; $upload_fieldname_final[$i] = ucwords(str_replace("_", " ", $key)); $fieldvalue[$i] = $uploadlink[$i]; $i++; } if ($upload_Size[$i] >= $max_filesize) { $error .= "The size of $key (file: $upload_SrcName[$i]) is bigger than the allowed " . $max_filesize/1024 . " Kbytes!\n"; } } $crack[0] = '\n'; $crack[1] = '\r'; $crack[2] = "%0a"; $crack[3] = "%0d"; $crack[4] = "content-type:"; $crack[5] = "to:"; $crack[6] = "cc:"; $crack[7] = "bcc:"; $crack[8] = "mime-version:"; $crack[9] = "x0a"; $crack[10] = "x0d"; foreach ($_POST as $key => $value) { for ($k = 0; $k < count($crack); $k++) { if (substr_count(strtolower($value), $crack[$k])) { $error .= "The field $key contained e-mail headers ($crack[$k]) in the value submitted. This seems to be a cracking attempt and the message has not been sent.!
"; } } } if ($error) { $errorcode = file_get_contents($error_url); $replace = "##error##"; $errorcode = str_replace($replace, $error, $errorcode); echo $errorcode; exit; } $uploadfolder = basename($upload_folder); for ($i = 0; $i < count($upload_DstName); $i++) { $uploadFile = $uploadfolder . "/" . $upload_DstName[$i]; if (!is_dir(dirname($uploadFile))) { @RecursiveMkdir(dirname($uploadFile)); } else { @chmod(dirname($uploadFile), 0777); } @move_uploaded_file($upload_Temp[$i] , $uploadFile); chmod($uploadFile, 0644); } $internalfields = array ("submit", "reset", "filesize", "upload_folder", "send", "captcha_code"); $message .= "\n"; foreach ($_POST as $key => $value) { if (!in_array(strtolower($key), $internalfields)) { if (!is_array($value)) { $message .= ucwords(str_replace("_", " ", $key)) . " : " . $value . "\n"; } else { $message .= ucwords(str_replace("_", " ", $key)) . " : " . implode(",", $value) . "\n"; } } } if (count($upload_SrcName) > 0) { $message .= "\nThe following file have been uploaded:\n"; for ($i = 0; $i < count($upload_SrcName); $i++) { $message .= $upload_SrcName[$i] . " Link: " . $uploadlink[$i] . "\n"; } } mail($mailto, $subject, stripslashes($message), $header); header('Location: '.$success_url); exit; } ?> puppy questionnaire
Please provide your name , address and phone number.
Occupation
Spouse Occupation
Email
Web page
Where did you learn about this litter
Why have you decided to bring a Golden Retriever into your family?
Which do you prefer
Why
Does everyone in your family want this puppy?
If no explain
Other
Are there children in the family?
If yes gender and ages-
Does anyone in your family have allergies to dogs?
Has anyone in your family ever been bitten by a dog? If yes, please explain the occurence.
Do you own or rent your residence-if you rent have you obtained permission from your landlord to have this dog?
What type of residence so you live in.
Who will be the primary caregiver of this puppy?
Will someone be home during the day to let the puppy out to potty?
If no one will be able to let the puppy out to potty from your family what arrangments will you make for the puppy?
Where will the puppy be housed during the time you are not at home?
Do you plan to crate train the puppy? If not please explain your reasons in the space provided.
Do you have a securely fenced yard?
Do you secure your gates?
Do you have a dog run available for your new puppy?
If yes what is the size and layout of the dog run.
Are there any bylaws prohibiting you from owning a dog in your neighborhood?
Do you own any other pets?
If yes please list your pets.
Are you willing to take an obedience class with your puppy so they can become more enjoyable members of your family?
Have you ever owned and raised a puppy before? If so please list the breed/breeds of dogs you have owned.
Who will be training the puppy?
Do you have a regular veterinarian? If so please list the name, address and phone number of your vet in the space provided.
A new puppy is a big commitment are you willing to provide for all the puppies needs for it's whole lifetime?  These will include food, water, shelter, exercise, LOVE, veterinary care (shots, check ups, medeical care in case of injury), your time and training. 
Have you ever competed in any formal dog events before? Agility, Conformation, Flyball, Tracking, etc.  If so what levels have you achieved and what is your primary interest concerning your new puppy?
Are you looking for any specific personality type in your new puppy?
If you are interested in breeding this puppy are you willing to complete the following medical tests and AKC or CKC titles prior to breeding?
OFA Hip and Elbow clearances, CERF Eye clearance, Heart clearance by a board certified cardiologist.

If you are not willing to complete these tests or titles please provide your reasons in the space provided.
Are you willing to spay or neuter this dog?
Are you willing to provide your new puppy with a high quality food and take care in your feeding to ensure your puppy is at a healthy wieght at all times?You will also need to provide exercise for your new puppy!
Please complete the entire puppy questionnaire below! This will let me get to know you and have an idea about the home you will provide one of my puppies!
Working and/or conformation titles from the AKC and/or CKC clubs.
I understand that submitting this questionnaire does not guarantee I will be approved for a puppy.
I understand and agree to the terms and conditions set by this questionnaire.
Please provide any other information in the space provided that will help me place the right puppy in your home.
All of our companion or pet puppies are sold with AKC Limited Registration and
spay/neuter contracts. This means that the dog is registered with AKC however none
of the offspring are eligible for registration.
A dog with a Limited Registration as well as a spayed or neutered dog can compete
in all AKC events except in the Conformation classes (breed ring).
Once we have recieived your completed application we will contact you either through email or by phone to discuss your eligibility for a Splendid Golden Retriever Puppy!
Thank you for inquiring about a Splendid Golden Retriever!